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Leaders in the U.S. Senate yesterday unveiled the Better Care Reconciliation Act of 2017, intended to repeal and replace the Affordable Care Act. A copy of the bill is here, and official summary is available here. Our initial review focuses on the following provisions that would have the most impact on public health and on maternal and child health systems:Medicaid and Coverage Requirements – The bill proposes to roll back the ACA’s Medicaid expansion over three years and eliminates the requirement for individuals to have insurance. The Congressional Budget Office is expected to issue an estimate early next week on how these combined policies will affect coverage levels, and as a reminder the House-passed bill was estimated to cause over 20 million Americans to lose insurance. The bill also includes the House-passed option for states to choose either a block grant or per capita cap, with the Senate proposing tighter caps that would limit future program increases to the rate of inflation overall rather than Medical inflation (which is typically higher). The bill also proposes a new option to allow states to eliminate Medicaid benefits for non-disabled, non-elderly, non-pregnant adults, beginning October 1, 2017, who do not fulfill work requirements. It appears this could penalize a woman who does not meet work requirements a short time after giving birth by requiring a mother to fulfill work requirements just 60 days after the end of the month her pregnancy ends. Benefits – The Senate bill proposes to sunset the requirement for plans to cover Essential Health Benefits by 2020. This reverses requirements to cover clinical preventive services, contraception with no cost-sharing, maternity care, mental health, substance abuse and addiction coverage, and other services important to promoting and protecting health.Prevention Fund – The bill proposes to eliminate the Prevention and Public Health Fund beginning in FY 2018, which would create a 12 percent gap in the CDC’s budget. On the positive side, the bill:Appears to retain existing protections for people with pre-existing conditions,Includes potentially more generous income-based subsidies for those in the individual market than those proposed by the House,Creates a $2 billion fund one-time for states to expand treatment for opioid addiction (although this is estimated to be billions short of actual needs),Provides exemptions from optional state Medicaid work requirements for pregnant women, single parents with children below age 6, and disabled individuals and their caretakers,Appears to include a carve out from Medicaid per capita caps for “medically fragile children,” andIncludes a stabilization fund to help states strengthen their individual health insurance markets at $15 billion a year in 2018 and 2019, $10 billion a year in 2020 and 2021. There is also a long-term State Innovation Fund, $62 billion over eight years, to help high-cost and low-income people buy health insurance.What Happens Next: The Senate is expected to vote on the bill next week. Most medical, public health, and MCH groups are strongly opposing the bill. The Association of State and Territorial Health Officials released a statement here urging the Senate to oppose the repeal of the Prevention and Public Health Fund. Because AMCHP is a nonpartisan organization representing all states, we do not have a consensus position on the overall legislation.?We do, however, urge all individual maternal and child health leaders to share your views with your elected officials, in accordance with your organizations’ rules on advocacy. In the coming days we will share additional analysis, updates, and resources as available. ................
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